NPI | 1619286234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2010033344) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2010033344) |
101YM0800X Counselor, Mental Health (Licence: MO 2010033344) | |
Enumeration Date | 2010-09-30 |
Last Update Date | 2016-02-16 |